[Fracture of the femoral diaphysis in children. Ascending or descending centro-medullary nailing? A choice of principle or of necessity?].

Over a period of 4 years, 40 children between the ages of 6 and 14 years (mean: 10 years) were treated for a fracture of the femoral shaft (39 closed fractures and 1 Cauchoix type I open fracture) by flexible medullary nailing, either ascending (5 cases) or descending (35 cases). Although it is classical to use the ascending route described by the Nancy team, the sub-trochanteric descending route was preferred for its simplicity; non-involvement of the knee by the insertion of the nail allows earlier autonomy in children. The results have been found to be satisfactory; no complications related to the method were observed. The biomechanical principles are also conserved.